Comprehensive medication guide to Nitazoxanide including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$30 copay for generic nitazoxanide on most commercial plans (Tier 1–2); usually no prior authorization required. Brand Alinia typically at Tier 3–4 with higher copays; Romark co-pay card can reduce brand cost to $0 for commercially insured patients.
Estimated Cash Pricing
$833–$1,113 retail for generic nitazoxanide (6 × 500 mg tablets); as low as $223 with a GoodRx coupon or $229 with SingleCare — a savings of over 73% off retail. Brand Alinia retails at $1,350–$1,605 for the same 3-day course.
Medfinder Findability Score
55/100
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Nitazoxanide is an FDA-approved antiparasitic medication belonging to the thiazolide drug class. It is sold under the brand name Alinia, with FDA-approved generic tablets available since 2020. It is prescribed for the treatment of diarrhea caused by two common intestinal parasites: Giardia lamblia (giardiasis) and Cryptosporidium parvum (cryptosporidiosis) in immunocompetent patients.
Nitazoxanide is approved for adults and children 1 year of age and older. Adults and adolescents (12+) use the 500 mg tablet form; children ages 1-11 use the oral suspension. It is not a controlled substance, meaning any licensed healthcare provider can prescribe it without special restrictions.
Beyond its FDA-approved indications, nitazoxanide is used off-label for Clostridioides difficile (C. diff), Blastocystis species, Entamoeba histolytica, and has been investigated in clinical trials for influenza treatment due to its broad-spectrum antiviral properties.
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Nitazoxanide works by inhibiting an enzyme called pyruvate:ferredoxin oxidoreductase (PFOR), which is essential to the anaerobic energy metabolism of parasites like Giardia and Cryptosporidium. By blocking this enzyme, nitazoxanide disrupts the parasite's ability to produce energy, preventing it from surviving and reproducing.
After oral ingestion, nitazoxanide is rapidly hydrolyzed to its active metabolite, tizoxanide (also called desacetyl-nitazoxanide). Tizoxanide is highly protein-bound (>99.9%) in plasma and carries out the antiparasitic activity. Taking nitazoxanide with food nearly doubles the absorption of tizoxanide — this is why the medication must always be taken with a meal.
Human cells use a different energy metabolism pathway (oxidative phosphorylation with oxygen) that is not targeted by nitazoxanide. This selectivity explains the drug's favorable safety profile — it disrupts parasite energy production while leaving the patient's own cells largely unaffected.
500 mg — tablet
For adults and adolescents 12 years and older; take one tablet every 12 hours for 3 days with food
200 mg (10 mL) — oral suspension
For children ages 4-11 years; 10 mL of oral suspension (100 mg/5 mL) every 12 hours for 3 days with food
100 mg (5 mL) — oral suspension
For children ages 1-3 years; 5 mL of oral suspension every 12 hours for 3 days with food
Generic nitazoxanide 500 mg tablets are not in an FDA-declared shortage as of 2026, but finding them at a standard retail pharmacy can still be challenging. This is not a supply crisis — it is a stocking issue. Most pharmacies fill very few nitazoxanide prescriptions per year, so they don't maintain standing stock. Many pharmacies can order it within 24-48 hours if asked directly.
Brand Alinia has faced additional distribution challenges since generic competition entered the market in 2020. The brand oral suspension (for children 1-11 years) has no FDA-approved generic and is harder to locate. Hospital outpatient pharmacies and independent pharmacies are the most reliable sources for both forms.
Instead of calling pharmacy after pharmacy, use medfinder to find which pharmacies near you can fill your nitazoxanide prescription. medfinder contacts pharmacies on your behalf and texts you the results.
Nitazoxanide is not a controlled substance, so any licensed prescriber can write for it without special DEA authority or registration. This makes access to a prescription relatively straightforward through a wide range of providers.
Telehealth is available for nitazoxanide prescriptions in many cases. Because it is not a controlled substance, telehealth providers can prescribe it after evaluating your symptoms online or by video. This is most appropriate for otherwise healthy adults with classic giardiasis symptoms after known water or travel exposure. In-person evaluation with stool testing is preferred for complex cases.
No. Nitazoxanide is not a controlled substance and has no DEA scheduling. It requires a prescription but carries no special prescribing restrictions. Any licensed healthcare provider — including primary care physicians, nurse practitioners, physician assistants, pediatricians, and infectious disease specialists — can prescribe it in all 50 states.
Because it is not a controlled substance, nitazoxanide can be prescribed through telehealth visits in appropriate clinical situations, and prescriptions can be transmitted electronically without any special reporting requirements. There are no refill quantity limits, diversion risks, or monitoring programs associated with this medication.
Nitazoxanide is generally well-tolerated. In clinical trials, its side effect profile was not significantly different from placebo. The most commonly reported side effects (occurring in ≥2% of patients) are:
Serious side effects (rare — seek emergency care if these occur):
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Metronidazole (Flagyl)
Nitroimidazole antibiotic; first-line for Giardia; costs under $10 with coupons; available at virtually all pharmacies; requires alcohol avoidance; 5-7 day course
Tinidazole (Tindamax)
Nitroimidazole; single 2g dose for Giardia; high cure rates; fewer GI side effects than metronidazole; requires alcohol avoidance; available at most pharmacies
Paromomycin
Non-absorbable aminoglycoside; used for cryptosporidiosis and amebiasis; preferred in pregnancy; for intestinal parasitic infections where systemic absorption must be avoided
Albendazole
Benzimidazole anthelmintic; effective for Giardia and helminthic infections; less effective than nitroimidazoles for Giardia but useful when they are contraindicated
Prefer Nitazoxanide? We can find it.
Warfarin (Coumadin)
majorAvoid concurrent use. Tizoxanide is >99.9% protein-bound and competes with warfarin for plasma protein binding, potentially increasing free warfarin levels and bleeding risk.
Phenytoin (Dilantin)
majorAvoid or use alternative. Protein binding competition may alter levels of either drug. Narrow therapeutic index makes this interaction clinically significant.
Baricitinib (Olumiant)
majorAvoid concurrent use. Nitazoxanide inhibits OAT3 transporter, which reduces baricitinib elimination and increases its blood levels.
Valproic acid (Depakote)
majorAvoid or use alternative. Protein binding competition may alter valproate levels; narrow therapeutic index increases clinical risk.
Tacrolimus
moderateMonitor closely. Protein binding competition may alter tacrolimus levels; monitoring of tacrolimus levels is recommended if used together.
Glyburide
moderateMonitor closely. Protein binding competition may increase free glyburide levels; monitor blood glucose.
Nitazoxanide is a well-established, well-tolerated antiparasitic with a relatively simple 3-day treatment course. It is not a controlled substance, has no alcohol restriction (unlike metronidazole), and is approved for children as young as 1 year. The primary challenge for patients is finding it in stock — not a lack of availability at the supply level, but rather low stocking at retail pharmacies due to limited demand.
The most effective strategies for patients: ask your prescriber to write for the generic by name (nitazoxanide 500 mg), use GoodRx to reduce cost to approximately $223, and target hospital outpatient or independent pharmacies first. For those on commercial insurance, the Romark co-pay card can reduce brand Alinia cost to $0.
If you're having trouble locating nitazoxanide, medfinder can contact pharmacies near you to find which ones have it in stock — so you can start treatment without unnecessary delay.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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